The Complex Role of Implicit Bias Training in Health Equity

by Jon Scaccia November 14, 2023

In pursuing health equity, the role of implicit bias training has been widely debated. Two articles by Nao Hagiwara, “A call for grounding implicit bias training in clinical and translational frameworks” (PMC7265967) and “The Problem with Implicit Bias Training” (Scientific American), provide critical insights into the challenges and potential pathways forward in utilizing implicit bias training effectively within public health practice.

Hagiwara’s work examines the often inherent limitations of current implicit bias training programs. While well-intentioned, these programs sometimes lack the empirical evidence to demonstrate their effectiveness in creating lasting behavioral change. For example, while some interventions have shown a temporary reduction in Implicit Association Test (IAT) scores, they haven’t consistently led to a sustained narrowing of racial and ethnic clinical treatment disparities.

One central tenet of Hagiwara’s argument is a clinical and translational framework to ground implicit bias training. This approach suggests that training should not only aim to raise awareness about biases but also integrate practical steps that can be translated into everyday clinical practice. It’s not enough to recognize bias; public health practitioners must have the tools to alter their behaviors meaningfully.

Furthermore, Hagiwara points out that addressing individual biases without considering the broader systemic issues is a half-measure. Structural racism, embedded within healthcare and other organizations, presents significant barriers to maintaining any improvements made through individual-level interventions. For instance, race-adjusted clinical algorithms in medicine can lead to disparities in treatment, which are further compounded by stereotypes that label certain racial groups as noncompliant, often overlooking socioeconomic factors that influence health outcomes.

Despite the critiques, Hagiwara does not dismiss the value of implicit bias training outright. Instead, there is a call for more rigorous evaluations of these programs and for developing evidence-based interventions that can reduce discriminatory behaviors at the individual level. Success stories, such as removing race as a criterion for determining kidney function at the University of Washington, underscore the potential for structural change within healthcare organizations to promote equity.

As public health practitioners grapple with the complex layers of racial bias and healthcare disparities, the key takeaway from Hagiwara’s articles is the necessity of finding the most effective ways to counteract racial bias. This involves a multi-faceted approach that combines awareness with actionable strategies and addresses the systemic roots of health inequity.

In conclusion, implicit bias training, while a piece of the puzzle, is not a panacea. It must be part of a larger, more comprehensive strategy targeting individual behaviors and institutional policies. Only then can we hope to advance health equity in a meaningful and enduring way.

Key Takeaways for Public Health Practitioners:

1. Implicit bias training should be grounded in clinical and translational frameworks to ensure practical applicability.
2. Systemic changes are necessary to complement individual-level interventions for a holistic approach to health equity.
3. Ongoing research and evaluation of implicit bias training programs are essential to refine and implement effective strategies.

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